Saturday, March 6, 2010

Health Care Saturday

You can tell that the media is liberal by looking at the Sunday morning political talk show lineups. On Face the Nation, Lindsey Graham is balanced by Evan Bayh. On Meet the Press, Orrin Hatch is balanced by Harold Ford. On This Week, Mitch McConnell is balanced by no one. On Fox News Sunday, Mitt Romney is balanced by no one. On State of the Union, Tom DeLay is balanced out by Chris Van Hollen and Brian Baird. Obviously, that means there are no progressives and, aside from Van Hollen, no mainstream Democrats. It's extreme right-wingers matched up against the most 'centrist' Democrats in the business. The only person on any of these shows other than Van Hollen who will wholeheartedly defend the president's health care plan is Health & Human Services Secretary Kathleen Sebelius. That's how they game the system against us.

The Republicans think that the media is liberal because the reporters believe in things like global warming and the value of the United Nations and the theories of evolution and plate tectonics. But, just because the media is educated and cares about world opinion doesn't mean that they are helpful to liberal causes like avoiding senseless wars or extending health care accessibility to 30 million Americans. They're not helpful. If they were, they'd have invited Raul Grijalva and Sheldon Whitehouse on their shows instead of Harold Ford and Evan Bayh.

It's a truism that when the parties battle, some independents and non-political people turn off to both parties. But that hides the fact that there are winners and losers in the battle for public opinion. One big loser is health insurance companies, but they are only marginally less trusted than Republican Congressional leaders.

Americans remain more confident in the healthcare reform recommendations of President Obama (49%) than in the recommendations of the Democratic (37%) or Republican (32%) leaders in Congress. But these confidence levels are lower than those measured in June, suggesting that the ongoing healthcare reform debate has taken a toll on the credibility of the politicians involved.

Take a look at the numbers (click for bigger pic):

But take a look at the expanded graph for who the real losers are:

Republican leaders, 32. Health insurance 26. Losers.

Hey, you can take my word for it. I'm a doctor, and I come in at 77. And I'm telling you, health reform needs to pass. And I am far from alone.

Arguably the single biggest threat to health care reform is Rep. Bart Stupak (D-Mich.) and his dozen Democratic allies, who are threatening to kill the legislation over indirect, circuitous funding of abortion.

Efforts to work with Stupak are ongoing, but it's worth emphasizing a relevant detail: Stupak is just wrong about the underlying policy dispute. Whether he knows he's wrong, and he's just hoping to kill health care reform, is unclear. But the accuracy of Stupak's claims aren't in dispute: the facts aren't on his side.

ABC News did a nice job fact-checking Stupak's argument this week, and Slate's Tim Noah (a Monthly alum) published the definitive takedown a couple of days ago, explaining that some areas of the debate are open to interpretation and debate, but this isn't one of them: "Stupak happens to be wrong."

Ideally, this would be enough. Democratic leaders would explain the truth to Stupak and his allies, making the case on the merits -- the Senate compromise language, endorsed by center-right Dems who oppose abortion rights, already does what Stupak & Co. want, which is to prevent public funding of abortion.

But Stupak has been reluctant to listen to reason, and continues to make claims that simply fail to stand up to scrutiny. The new goal is to strike a related deal that would address Stupak's concerns in a separate-but-connected bill. That may or may not be enough.

If reform is going to pass, however, the votes are going to have to come from somewhere. Stupak claims to have a dozen "yes" votes in his pocket, all of whom will bolt and side with Republicans. Without them, Pelosi would need a dozen Blue Dogs who opposed reform in November to switch, which may prove too high a hurdle.

In the meantime, though, it's worth re-emphasizing reality -- Stupak's argument is factually in error. That will make negotiations with him more complicated -- lawmakers who stick to a mistake after it's been exposed as a mistake can be challenging to deal with -- but that's where we find ourselves.

Matt Miller hits on one of the most important points in the abortion and health-care debate. The practical effect of Bart Stupak's position is not that the federal government will not subsidize abortion by subsidizing health-care insurance. It is that it will not subsidize abortion by subsidizing health-care insurance for poor women. We already spend much more subsidizing coverage that includes abortion for richer women:

This entire debate is ridiculous, because the feds already subsidize abortions massively, via the giant tax subsidy for employer-provided care. Today the feds devote at least $250 billion a year to subsidizing employer-based coverage, a subsidy that skews incentives horribly (but which big business and big labor wouldn’t let the politicians touch this year). A Guttmacher Institute study says that 87 percent of typical employer plans cover abortion, and a Kaiser study found that 46 percent of covered workers had abortion coverage.

As I've written before, the Stupak amendment is as much about class as it is about choice. Imagine if Stupak attempted to expand his campaign to the coverage employed women receive. It would, after all, be the same principle: Federal policy should not subsidize insurance that offers abortion coverage. But it wouldn't have a chance. That group is too large and too affluent and too politically powerful for Congress to dare to touch its access to reproductive services. But the poorer women who will be using subsidies on the exchange are a much easier target.

"No problem is in more need of attention and action by Congress than the looming financial challenges of entitlement programs," reads John McCain's campaign Web site. But back in Congress, McCain isn't exactly making good on that promise: He has turned his attention to Medicare, and the action he has proposed will make the looming financial challenges of entitlement programs virtually impossible to correct.

Last night, John McCain introduced an amendment that makes Medicare immune to the reconciliation process. That's all fine, except for McCain's record: Of the nine reconciliation bills McCain has voted to pass during his time in office, four of them included substantial cuts to Medicare. For those keeping score at home, they were the Balanced Budget Act of 1995, the Omnibus Budget Reconciliation Act of 1989, the Balanced Budget Act of 1997, and the Deficit Reduction Act of 2005. The Balanced Budget Act of 1995, in particular, included many more cuts to Medicare than anything on the table today. Now he's saying that "entitlements should not be part of a reconciliation process." They're "too important."

The issue here isn't mere hypocrisy. It's dangerous shortsightedness. If McCain wants to try to strip the Medicare reforms from the health-care bill, that's his right. But to render Medicare untouchable to the reconciliation process will hamstring future congresses that need to make tough decisions to avert the consequences of the program's substantial deficit. In his zeal to attack the health-care reform bill, McCain is making it harder to address our entitlement spending. It's wildly irresponsible and shreds whatever remaining credential McCain had as a deficit hawk.

McCain may know that the campaign is over. But it's increasingly clear that he's not over it.

The final act was carefully choreographed. The rollout began a week earlier with a couple of shows of bipartisanship: a Feb. 25 Blair House "summit" with Republicans, followed five days later with a few concessions tossed the Republicans' way.

Show is the operative noun. Among the few Republican suggestions President Obama pretended to incorporate was tort reform. What did he suggest to address the plague of defensive medicine that a Massachusetts Medical Society study showed leads to about 25 percent of doctor referrals, tests and procedures being done for no medical reason? A few ridiculously insignificant demonstration projects amounting to one-half of one-hundredth of 1 percent of the cost of his health-care bill.

Reasonable people can disagree with whether state-run demonstration projects are the best way to figure out an effective medical malpractice system (they can also disagree with Krauthammer's number, which is eye-poppingly high, and bears no relationship to the demonstrated gains from tort reform. Many states have imposed harsh tort reforms and their medical system is barely any different. Texas is one of those states, yet McAllen is the national poster child for unnecessary care).

But whatever tort reform you attempt, it's not going to be expensive. Tort reform is a series of regulations that change the way lawsuits are handled. Saying that the experiments come to only "one-half of one-hundredth of 1 percent of the cost of his health-care bill" is saying exactly nothing about them. If they made all malpractice lawsuits illegal, they'd actually have a negative cost to the federal government, but by Krauthammer's logic, they'd be a total slap in the face to reform advocates.

It was just five years ago that Sen. Judd Gregg (R-N.H.) was so anxious to let oil companies drill the Arctic National Wildlife Refuge, he tried to use the budget reconciliation process to do it. "If you have 51 votes for your position, you win," he said at the time, adding, "Is there something wrong with majority rules? I don't think so."

This week, Gregg not only said there's something wrong with majority rules, he manufactured a bizarre history of the Senate that exists only in his imagination.

[U]nder the Senate rules, anything that comes across the floor of the Senate requires 60 votes to pass. It's called the filibuster. That's the way the Senate was structured. [...]

The Founding Fathers realized when they structured this they wanted checks and balances. They didn't want things rushed through. They saw the parliamentary system. They knew it didn't work... That's why we have the 60-vote situation over here in the Senate to require that things get full consideration.

That guy named Judd Gregg who said, "If you have 51 votes for your position, you win"? Yeah, he's gone missing, and has been replaced with this shameless hack.

It's hard to overstate how truly ridiculous Gregg's analysis is. It simply has no foundation in reality. The Senate wasn't "structured" to require supermajorities on literally every bill, nomination, and resolution -- that's the exact opposite of the truth. This isn't a subjective question open to interpretation; Gregg is just lying.

And when Gregg says the framers of the Constitution "saw the parliamentary system" and rejected it, he's just making things up. Matt Yglesias, who refers to Gregg as "an idiot," explained, "There were no countries operating on a modern parliamentary system when the constitution was written. And why doesn't it work? It seems to work in Australia, Belgium, Canada, Denmark, Finland, Germany, Hungary, India, Japan, Korea, etc."

Keep in mind, Gregg spent years nurturing a reputation as something of a high-minded moderate. Indeed, the New Hampshire Republican briefly agreed to join President Obama's cabinet last year, before abruptly changing his mind. Now that he's retiring from Congress, the senator can finally be himself. Released from the burdens of satisfying donors or impressing voters, Gregg can be as honest and as honorable as his conscience dictates.

On Fox News last week, Sen. Judd Gregg (R-AZ) declared that using reconciliation “to pass the most significant piece of public policy” of his lifetime would be “a railroading of the system”:

GREGG: We’re talking now about changing the entire way that health care is delivered in this country. We’re talking about taking the federal government and growing it from 20 percent of the economy to 25, 26 percent of the economy. We’re talking about changing the way that you and your doctor interact and you and your hospital — and your hospital treats you. These are huge public policy issues which really are way outside the reconciliation concept because they need debate. They need discussion. And they need to be subject to amendments on the floor of the Senate in order to do them correctly, or at least to have a proper airing of them and a fair treatment of them.

GREGG: But that’s what the game plan here is. Is to pass that bill, the big bill, and what they’re doing is they’re using this other bill, reconciliation, to basically buy off votes in the House from the more liberal members of the House who want to make this bill even bigger and more intrusive. And when they get those votes and they pass the big bill, that will go down to the president and it will be signed. And this side bill, which is called the reconciliation bill, will really become almost irrelevant. I mean, as a very practical matter, there isn’t really going to be a lot of people who really care whether it passes or not because they will have already gotten their massive bill through and it will be law.

Later in the interview, Gregg further contradicted his previous claims that reconciliation would be used as “an entire rewrite of the health care system of America.” “Even if they did something else, it would be at the margins. I mean it’s not going to dramatically impact what is this huge bill that will then be law,” said Gregg.

Greg Sargent has more great reporting about the GOP's latest plan to derail the health care bills. Remember, the plan is Pass Then Patch: House votes on the Senate bill, then House votes on the relatively small reconciliation bill that makes relatively small changes, and then the Senate votes on the reconciliation patch.

The new plan is for the GOP to challenge lots of provisions in the patch as violations of the Byrd rule. The hope, according to Sargent's reporting, is to force at least one change, which would then mean that they House would have to vote yet again. The real plan, however, is to scare House Democrats into voting against the main (Senate-passed) bill, because the Dems are nervous about whether the Senate will leave them hanging once again.

The problem with the new plan is that the Democrats are not going to have any problem at all in passing the reconciliation bill: it's all ice cream, no spinach. The "patch" part of Pass Then Patch is made up of repealing various deals that the GOP has been complaining about; trading in the (unpopular) Cadillac tax for a (popular) tax on rich people; the GOP ideas that Obama put in his letter to Ried and Pelosi this week; and a bunch of other relatively popular items. If looked at as a stand-alone bill -- which it will be, at that point -- I'm guessing that well over 55 Senators will support it, and I would set a betting line at 58. And take the over. All the problems are with finding 217 (or whatever the number turns out to be) for the main bill.

The deeper problem with the new plan for the GOP is that as far as I can tell, the patch bill is being pretty carefully drafted to avoid Byrd rule problems.

The even deeper problem with the new plan for the GOP is that it puts them in a position of opposing repeal of the Nelson deal, the Florida deal, etc. The one thing that I believe might be very vulnerable to a Byrd rule challenge is lifetime caps. Does the GOP think that it can hold all 41 Republicans on that issue? I don't. Moreover, do they really want a vote on lifetime caps?

The yet even deeper problem with the new plan for the GOP is that if they do manage to stop the patch, then health care reform would still have passed.

Granted, none of that matters if the Democrats hear "Republicans have a plan" and hightail it for those hills were always hearing about. As I read the coverage, however, the House Democrats are getting over their concerns about the Senate, and we're down now to the core issue of Democrats who want the bill to pass, but without their vote. I don't see how this latest GOP tactic speaks to that situation. Or at least, House Dems should be getting over their concerns about the Senate. Yes, the Senate has double-crossed them before, many times, but this time the Senate has an easy vote remaining, not a hard one.